Medicare AdvantageAdministrativeMedium impact
Hints for HEDIS® (and more)
Blue Cross Blue Shield of Rhode Island·RI · Orthopedics, Family Medicine, Internal Medicine +2 more·Physician
Effective date
May 1, 2021
We identified it
Jun 19, 2026
Summary
BCBSRI released guidance for HEDIS Osteoporosis Management in Women (OMW) quality measure for Medicare Advantage members ages 67-85 who had fractures. The policy outlines specific CPT and HCPCS codes to use for BMD tests and osteoporosis medications, with a 6-month window to close care gaps after fracture occurrence.
Action Required
Billing team should review fracture claims for Medicare Advantage women ages 67-85 to ensure proper coding of BMD tests using CPT codes 76977, 77078, 77080, 77081, 77085, 77086 and osteoporosis medications using HCPCS codes J0897, J1740, J3489, J3110, J3111. Coordinate with providers to ensure follow-up care is completed within 6 months of fracture date to meet HEDIS quality measures. Contact BCBSRI Quality Team at QualityHEDIS@bcbsri.org or (401) 459-1005 for gap closure support.